The Burden of Chronic Low Back Pain

Gore, Mugdha; Sadosky, Alesia; Stacey, Brett R.; Tai, Kei Sing; Leslie, Douglas L.

doi:10.1097/brs.0b013e318241e5de

Cited by 547 publications

(251 citation statements)

References 45 publications

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“…Disabling Chronic Low Back Pain (CLBP) impairs quality of life (QoL), impacts healthcare systems and burdens societies worldwide 1, 2, 3. For the majority of people suffering from CLBP, it is difficult to identify abnormalities in specific spinal structures as the cause of their symptoms 4, 5 and they are often referred to as having Non‐Specific Low Back Pain (NSLBP), although some reports advocate the use of precision diagnostic blocks in an attempt to circumvent this 6.…”

Section: Introductionmentioning

confidence: 99%

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Deckers

Smedt

Mitchell³

et al. 2018

Neuromodulation: Technology at the Neural Interface

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ObjectivesThe purpose of the international multicenter prospective single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain (CMLBP) in patients who have failed conventional therapy and are not candidates for surgery or spinal cord stimulation (SCS).Materials and MethodsFifty‐three subjects were implanted with a neurostimulator (ReActiv8, Mainstay Medical Limited, Dublin, Ireland). Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve. The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale (NRS). Responders were defined as subjects with an improvement of at least the Minimal Clinically Important Difference (MCID) of ≥2‐point in low back pain NRS without a clinically meaningful increase in LBP medications at 90 days. Secondary outcome measures included Oswestry Disability Index (ODI) and Quality of Life (QoL; EQ‐5D).ResultsFor 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided satisfactory pain relief, the responder rate was 58%. The percentage of subjects at 90 days, six months, and one year with ≥MCID improvement in single day NRS was 63%, 61%, and 57%, respectively. Percentage of subjects with ≥MCID improvement in ODI was 52%, 57%, and 60% while those with ≥MCID improvement in EQ‐5D was 88%, 82%, and 81%. There were no unanticipated adverse events (AEs) or serious AEs related to the device, procedure, or therapy. The initial surgical approach led to a risk of lead fracture, which was mitigated by a modification to the surgical approach.ConclusionsElectrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP. Results demonstrate clinically important, statistically significant, and lasting improvement in pain, disability, and QoL.

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Section: Introductionmentioning

confidence: 99%

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Deckers

Smedt

Mitchell³

et al. 2018

Neuromodulation: Technology at the Neural Interface

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“…l Co-psychological well-being -Hospital Anxiety and Depression Scale (HADS), 58 Pain Catastrophizing Scale (PCS), 59 SF-12 and BPI. l Health-care utilisation and costs and impact on productivity -Stanford Presenteeism Scale (SPS) 6,60 self-reported measures of sickness absence over the previous 3 months and health-care utilisation in the form of hospital visits, treatments and medications. These data were collected at each outcome visit on the case report form.…”

Section: Discussionmentioning

confidence: 99%

“…4 Chronic LBP, with a prevalence of 3-10%, 5 is associated with depression, anxiety, deactivation, inability to work and substantial societal costs. 1,6 Common contributors to LBP in adults are thought to include lumbar facet-joints. 7 These are paired synovial joints between the superior and inferior articular processes of consecutive lumbar vertebrae and between the fifth lumbar vertebra and the sacrum.…”

Section: Introductionmentioning

confidence: 99%

Facet-joint injections for non-specific low back pain: a feasibility RCT

Snidvongs

Taylor

Ahmad

et al. 2017

Health Technol Assess

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BackgroundPain of lumbar facet-joint origin is a common cause of low back pain in adults and may lead to chronic pain and disability, with associated health and socioeconomic implications. The socioeconomic burden includes an inability to return to work resulting in loss of productivity in addition to direct and indirect health-care utilisation costs. Lumbar facet-joints are paired synovial joints between the superior and inferior articular processes of consecutive lumbar vertebrae and between the fifth lumbar vertebra and the sacrum. Facet-joint pain is defined as pain that arises from any structure that is part of the facet-joints, including the fibrous capsule, synovial membrane, hyaline cartilage and bone. This pain may be treated by intra-articular injections with local anaesthetic and steroid, although this treatment is not standardised. At present, there is no definitive research to support the use of targeted lumbar facet-joint injections to manage this pain. Because of the lack of high-quality, robust clinical evidence, the National Institute for Health and Care Excellence (NICE) guidelines on the management of chronic low back pain [NICE.Low Back Pain in Adults: Early Management. Clinical guideline (CG88). London: NICE; 2009] did not recommend the use of spinal injections despite their perceived potential to reduce pain intensity and improve rehabilitation, with NICE calling for further research to be undertaken. The updated guidelines [NICE.Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE guideline (NG59). London: NICE; 2016] again do not recommend the use of spinal injections.ObjectivesTo assess the feasibility of carrying out a definitive study to evaluate the clinical effectiveness and cost-effectiveness of lumbar facet-joint injections compared with a sham procedure in patients with non-specific low back pain of > 3 months’ duration.DesignBlinded parallel two-arm pilot randomised controlled trial.SettingInitially planned as a multicentre study involving three NHS trusts in the UK, recruitment took place in the pain and spinal orthopaedic clinics at Barts Health NHS Trust only.ParticipantsAdult patients referred by their GP to the specialist clinics with non-specific low back pain of at least 3 months’ duration despite NICE-recommended best non-invasive care (education and one of a physical exercise programme, acupuncture or manual therapy). Patients who had already received lumbar facet-joint injections or who had had previous back surgery were excluded.InterventionsParticipants who had a positive result following a diagnostic test (single medial branch nerve blocks) were randomised and blinded to receive either intra-articular lumbar facet-joint injections with steroids (intervention group) or a sham procedure (control group). All participants were invited to attend a group-based combined physical and psychological (CPP) programme.Main outcome measuresIn addition to the primary outcome of feasibility, questionnaires were used to assess a range of pain-related (including the Brief Pain Inventory and Short-Form McGill Pain Questionnaire version 2) and disability-related (including the EuroQol-5 Dimensions five-level version and Oswestry Low Back Pain Questionnaire) issues. Health-care utilisation and cost data were also assessed. The questionnaire visits took place at baseline and at 6 weeks, 3 months and 6 months post randomisation. The outcome assessors were blinded to the allocation groups.ResultsOf 628 participants screened for eligibility, nine were randomised to receive the study intervention (intervention group,n = 5; sham group,n = 4), six completed the CPP programme and eight completed the study.LimitationsFailure to achieve our expected recruitment targets led to early closure of the study by the funder.ConclusionsBecause of the small number of participants recruited to the study, we were unable to draw any conclusions about the clinical effectiveness or cost-effectiveness of intra-articular lumbar facet-joint injections in the management of non-specific low back pain. Although we did not achieve the target recruitment rate from the pain clinics, we demonstrated our ability to develop a robust study protocol and deliver the intended interventions safely to all nine randomised participants, thus addressing many of the feasibility objectives.Future workStronger collaborations with primary care may improve the recruitment of patients earlier in their pain trajectory who are suitable for inclusion in a future trial.Trial registrationEudraCT 2014-003187-20 and Current Controlled Trials ISRCTN12191542.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 74. See the NIHR Journals Library website for further project information.

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“…дицинская и социальная проблема, а повышение эффек-тивности ее контроля относится к числу наиболее важных задач, стоящих перед современной медицинской наукой [1][2][3][4]. К сожалению, эта задача далека от своего решения.…”

unclassified

Analgesic treatment, by using a systemic algorithm

Евгеньевич¹,

Алексеева²

2015

RJTAO

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Хроническая мышечно-скелетная боль (МСБ) -ос-новное проявление болезней костно-мышечной систе-мы (БКМС), в наибольшей степени определяющее стра-дания пациентов, потерю трудоспособности и социаль-ной активности, а также существенные затраты на лече-ние и диагностические мероприятия. Более того, высту-пая в роли фактора, способствующего прогрессирова-нию заболеваний сердечно-сосудистой системы (ССС), хроническая МСБ не только ухудшает качество жизни пациентов с БКМС, но и уменьшает ее продолжитель-ность [1][2][3][4][5].В то же время отчетливое «старение» современной по-пуляции приводит к непрерывному росту числа больных с патологией опорно-двигательного аппарата, прежде всего остеоартрозом (ОА) и хронической неспецифической бо-лью в нижней части спины (НБНЧС). Соответственно, рас-тет и число лиц, страдающих МСБ. Поэтому в последние годы хроническая МСБ рассматривается как глобальная ме-

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The Burden of Chronic Low Back Pain

Abstract: Patients with CLBP are characterized by greater comorbidity and economic burdens compared with those without CLBP. This economic burden can be attributed to greater prescribing of pain-related medications and increased health resource utilization.

Cited by 547 publications

References 45 publications

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Facet-joint injections for non-specific low back pain: a feasibility RCT

Analgesic treatment, by using a systemic algorithm

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